Pediatric Intussusception

by Carlo Raj, MD

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    00:01 Our topic now goes into pediatric intussusception.

    00:05 How did this take place? Well, intussusception here, maybe perhaps there is a vasculitis taking place of the intestines such as Henoch-Schönlein purpura.

    00:16 Maybe there is that Meckel's diverticulum or maybe in general, you just had folding of one intestine to the other.

    00:24 Folding.

    00:25 There’s something called intussuscipien, intussusceptum.

    00:27 That’s a little bit too much detail.

    00:29 The point is that the – there’s telescoping.

    00:32 Think about telescope. What do you do with a telescope? You pull it out.

    00:35 When you want to see something and you put it back in.

    00:39 Well, that’s what’s happening with intussusception.

    00:41 One area of the intestine is folding into another.

    00:45 Literally, telescoping.

    00:47 This is not good.

    00:49 The child is going to then have bilious vomiting.

    00:52 The child may then be passing blood through the stool.

    00:56 You might have heard of something called currant jelly stool.

    00:59 It looks so incredibly appetizing.

    01:02 I’m sorry that I’m being a little sick here, but whatever.

    01:04 It does, it looks like currant jelly.

    01:06 Amazing! There’s blood in the stool.

    01:09 In addition, When you feel the abdomen, but this time, you have a folding.

    01:15 This is not an olive.

    01:17 An olive means what? Pyloric stenosis.

    01:20 So what is this? You’re feeling a sausage and I’ll show you a picture upcoming.

    01:25 Let’s talk about intussusception.

    01:27 A portion of the GI tract telescoping into the portion distal to it.

    01:32 Early: six to two years of age.

    01:35 In fact, as rule of thumb in practice, you have an infant or a child between two months to two years with obstruction and colic.

    01:49 At this point, with that type of history, you are being very aggressive in terms of investigating intussusception.

    01:56 It is associated with lymphoid hyperplasia, Peyer’s patches, Meckel’s diverticulum or perhaps even rotavirus vaccine.

    02:07 Signs and symptoms would be the following.

    02:09 Acute onset, cramping, intermittent pain to the point where the child and the infant is crying, lethargy.

    02:17 What does currant jelly stool mean to you? It’s dark.

    02:20 Why? There’s passage of blood with the stool.

    02:24 And upon examination, sausage-shaped mass.

    02:30 I’ll show a picture where you’ll never forget it.

    02:32 Diagnosis: Clinical history is sufficient for intervention.

    02:36 By clinical history, we mean there’s quite a bit of colic and pain between the ages of two months and two years.

    02:42 Ultrasound, plain films are supportive.

    02:46 And air enema is diagnostic and therapeutic.

    02:50 That’s what you’re paying attention to.

    02:52 Literally, remember, this is causing what kind of obstruction? Mechanical obstruction.

    02:57 So therefore, barium enema is actually going to then cause, well, increasing diameter of the intestine.

    03:04 And very much, it’s going to relieve the child’s discomfort, diagnostic and therapeutic.

    03:11 You definitely want to know those tests, which then provide both those types of experiences or those type of luxuries.

    03:24 Enema reduction successful in 50% of your cases, in fact apart from it being diagnostic.

    03:30 And take a look at this please.

    03:32 Let me walk you through this.

    03:33 On the left end, you find that there’s a little bit of -- it’s a smaller end, meaning to say that that was a normal intestine.

    03:43 It folded into the distal portion.

    03:46 And that red, beefy type of intestine that you’re seeing there, If you were feel that in the abdomen, it would feel like what? A sausage.

    03:57 With such pictures, I believe that there’s absolutely no way that you are going to miss such questions.

    04:03 Sausage shape.

    04:05 Currant jelly.

    04:06 The child being quite discomfort.

    04:08 Welcome to intussusception.

    About the Lecture

    The lecture Pediatric Intussusception by Carlo Raj, MD is from the course Pediatric GI Pathology.

    Included Quiz Questions

    1. Paralytic ileus
    2. Henoch-Schonlein purpura
    3. Polyps
    4. Meckel's diverticulum
    5. Rotavirus vaccine
    1. Currant-jelly stools
    2. Rice-water stools
    3. Hematochezia with mucus
    4. Foul-smelling, mucoid stools
    5. Melena
    1. Air enema
    2. Ultrasound scan
    3. Colonoscopy
    4. Gastroscopy
    5. Plain X-ray
    1. Sigmoidoscopy
    2. USG abdomen
    3. Air enema
    4. Barium enema
    5. X-ray plain films
    1. A part of the intestine curled up into the other part of the intestine
    2. Hypertrophy of the pyloric part of the stomach
    3. Twisting of the bowel wall
    4. Necrosis and inflammation of the bowel wall
    5. Inflammation of a diverticulum arising about 2 feet from the ileocecal junction

    Author of lecture Pediatric Intussusception

     Carlo Raj, MD

    Carlo Raj, MD

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